Healthcare Provider Details

I. General information

NPI: 1902990724
Provider Name (Legal Business Name): FRANK SAN GIOVANNI LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BARBARA LOOP SE
RIO RANCHO NM
87124-1039
US

IV. Provider business mailing address

423 SANTA FE AVE SW
ALBUQUERQUE NM
87102-4163
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax: 505-891-1768
Mailing address:
  • Phone: 505-977-1988
  • Fax: 505-244-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0448
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: